Papilloma is a benign skin neoplasm, a distinctive feature of which is a papilla base of connective tissue covered with epithelium on top. Papillomas appear in humans in various areas of the body (on the skin, mucous membranes, internal organs and other localizations) and in most animals.
Papillomas develop from the transitional or squamous epithelium in the form of soft, dense formations on the so-called peduncle. The size of these formations usually varies from 1 to 2 centimeters in diameter, and their outer surface has a white or dirty brown tint. Sometimes papillomas grow in different directions and become like cauliflower or a rooster's comb.
Papillomas are removed for a cosmetic effect if they appear on visible areas of the body - on the neck, arms, face, however, if they occur in many areas of the mucous membrane, for example, on the larynx, patency disorders can be provoked, whichthreaten the patient's life. In the case of the larynx, papilloma can block the airways, causing problems with the voice or the inability to breathe normally, in the case of the bladder, papillomas cause hematuria. If more papillomas are formed on the body, this indicates the onset of papillomatosis.
Etiology of papillomas
For the most part, the onset of papillomas is provoked by a viral infection - human papillomavirus (HPV), although sometimes papillomas can occur congenital or as complications of inflammatory diseases.
When HPV enters the human body, its activity usually begins to manifest itself after a long time. Often, some provoking factors contribute to the activation of the papillomavirus, as a result of which soft neoplasms begin to appear on the skin or mucous membranes. The main factors provoking papillomas, experts include stress, decreased immunity, weakening of the body due to treatment, vitamin deficiency in the body, injury to the skin.
Basically, people are sexually infected with papillomavirus, however cases of home infection with very low immunity or in the presence of damaged skin areas on the body that can come into contact with an HPV carrier are also possible. The appearance of papillomas indicates the activation of the existing virus, which is equally possible for women and men. A baby can become infected with this virus as it passes through an infected mother's birth canal.
Classification of HPV manifestations
The human papillomavirus that infects mucous membranes and skin can be classified into the following forms:
- clinical form that can be detected during a routine examination: genital, papular and papillary warts, exophytic warts, as well as cervicitis and cervical erosion in women;
- subclinical form, in which the formations have no symptoms, are not visible and can be detected only during endoscopy: inverted formations (growing inward in the mucous membranes), flat warts and warts in the cervical canal;
- latent form, characterized by the absence of a clinic and detected exclusively by the test results;
- female form or cervical form, expressed by cervical cancer or dysplasia of various stages.
When women are infected with highly oncogenic HPV as a result of sexual contact, the likelihood of malignant neoplasms in the cervical canal increases significantly. If infected with other types of viruses, the likelihood of oncology is not so high, however, a cancerous tumor can occur in the rectum or oral cavity. In men, the likelihood of cancer due to HPV exists in the anus, penis and rectum.
Types and forms of papillomas
It is very important to correctly identify the papillomas that appear on the body. Their types directly depend on the resulting strain of the virus, which, entering the human body, contributes to the process of excessive cell division in the skin, resulting in papillomas.
HPV strains can be oncogenic and non-oncogenic. There are many other non-oncogenic varieties and, as a rule, they bring nothing to the patient except external aesthetic discomfort.
This manifestation can be easily removed, thus solving the problem. However, if neoplasms occur in the area of the mucous membranes, this indicates serious pathological processes. Such a dislocation means that a person has been infected with an oncogenic HPV strain, therefore complex antiviral therapy is extremely necessary. To distinguish between different types of papillomas, it is enough to simply compare them with each other and identify the distinctive features of one or another subspecies.
Simple warts
Papillomas or simple warts are the most common type of papillomavirus caused by multiple strains at the same time. These HPV strains are transmitted not only sexually, but also through contact and daily life, which leads to statistics indicating that 30% of the world population has encountered HPV at least once in their life.
Simple papillomas or vulgar (common) warts are most often localized on the upper extremities, that is, on the hands, but sometimes they can also occur on the body, soles and feet, palms, fingers. Their peculiarity is that such warts appear in places with damaged skin due to a decrease in local immunity. Such papillomas occur in the area of the soles of the feet or palms due to contact with poor-quality household chemicals, profuse sweating, various skin damage, dermatitis.
The vulgar wart appears externally as papillary neoplasms of the skin a couple of millimeters in diameter at the beginning of the disease. In this case, the head of the wart has a smooth, soft texture and rises above the surface of the skin. It is poorly pigmented and its root penetrates deep into the skin, where it receives nourishment from the vessels. As a result of such nutrition, warts gradually grow, while not only their size changes, but also the degree of pigmentation. In addition, hair often grows in the center of such papillomas, which is a variant of the norm and does not indicate a malignant neoplasm.
Flat papillomas
Skin growths like these look like small flat yellowish plaques that rise slightly above the surface of the skin. Their structure is dense, with a deep subcutaneous root, as evidenced by frequent pains when pressing on the wart or when it is damaged in everyday life. Localization of such papillomas is most often the face and hands. They can sometimes occur in the anus or labia majora in women and in the scrotum in men. Due to the active blood supply, they have an active upward trend.
The main feature of flat papillomas is the difficulty of their treatment. After surgical treatment of these neoplasms, scars and scars usually remain in place.
Genital warts
Genital warts occur in the groin area or mucous membranes. Externally, these are thin papillary neoplasms 2-3 millimeters in diameter. Such warts grow rapidly, forming a large skin growth from a small single papilla, similar to a cauliflower or cockscomb.
The main danger of genital warts is the high risk of infection, inflammation of neoplasms in the vagina or labia minora in women. They can be easily injured, after which the infection penetrates the body at high speed. Furthermore, a major problem associated with genital warts is the high risk of recurrence, which is not reduced even with the use of antiviral treatments and with the removal of neoplasms. Several strains of the virus can cause genital warts, some of which can be dangerous for women in terms of the malignant process.
Filiform papillomas
Threaded papillomas with a thin stem, the top of which is crowned by the head of the neoplasm. They are very difficult to confuse with other species due to their special appearance, therefore, looking at the photo of filamentous papillomas, they can be differentiated from other varieties.
Such neoplasms appear more often after 45 in areas where thin skin prevails: on the chest, armpits, neck. The increase in the size of such neoplasms is their further lengthening. The head of filamentous papillomas is usually yellowish or pinkish, the pigmentation is not expressed, most often very weak.
Internal moles
Any neoplasm on the surface of a person's internal organs can be classified as a subset of internal moles. These are intragastric condylomas, papillomas in the rectum, neoplasms of the throat and mouth, neoplasms on the walls of the bladder. A distinctive feature of these papillomas is the impossibility of their recognition without carrying out appropriate medical and diagnostic procedures. However, the disease can be suspected by special symptoms. The danger of such neoplasms is identified in each case.
If papillomas are present in the bladder, bleeding or cancer may develop over time.
If the papilloma is found in the larynx, it helps to block breathing and interferes with the person's speaking function.
Lewandowski-Lutz papillomas
Verrucous epidermodysplasia or Lewandowski-Lutz papilloma is a very rare disease that mainly affects only children or adolescents. It happens that such a disease can be inherited and spread in a family.
The clinical picture of the disease manifests itself in the form of numerous red-brown spotted warts in the area of the feet and hands. A feature of the pathology is the fact that when papillomas are located on areas of the body exposed to ultraviolet radiation, in a third of cases they are reborn into malignant neoplasms and grow in the area of neighboring tissues.
Papilloma localization sites
Filamentous, vulgar or pointed papillomas, as well as condylomas, are the most common in the practice of doctors. The place of localization of filamentous warts is the face, vulgar ones are most often found in the area of the feet or hands, and condylomas are found exclusively on the mucous membranes (the head of the penis and in the urethra in men, in the area of the labia minoraand vagina in women), but it happens that any of these warts can occur in an unusual place for themselves.
It is not difficult to remove such papillomas in modern conditions, but the danger is the fact that with a decrease in immunity, new papillomas can reappear, which will lead to more serious health consequences, for example, the subsequent occurrence ofGenital warts is fraught with the development of cervical cancer in women uterus. Plantar warts are most common on rough soles and toes. Occasionally, a thorn can develop on the thumb after severe skin damage in the area.
In general, papillomatosis is a generalized form of pathology, in which neoplasms form throughout the human body. These growths have a characteristic appearance, therefore, having once seen the manifestations of the disease, they can no longer be confused with any other disease.
HPV Symptoms
The most common symptom of papillomavirus in the human body is the appearance of papillomas on the skin.
The rest of the symptoms depend directly on the location and type of the disease. Depending on the above signs, HPV symptoms may be the following:
- Genital warts occur on the mucous membranes of the genitals, mouth, larynx, rectum and the inner surface of the stomach. Symptoms of the onset of pathology in the genital area are itching and an unpleasant smell. If such symptoms begin to bother, in no case should they be ignored, since very often the cause of its occurrence can be of an oncogenic nature.
- Intraductal papillomas in the area of the ducts of the mammary glands, the signs of which are redness in the nipple area, slight itching and burning. Also, if you press on the nipple with such a papilloma, the ichore or green discharge begins to come out of it. The danger of intraductal papilloma is its gradual and possible degeneration into breast cancer.
- Plantar warts are expressed in active calluses in the area of the soles of the feet, which, when walking or pressing on it, cause acute pain.
- Papillomas in the larynx area are not initially expressed in any specific symptoms, but gradually this pathology leads to a change in a person's voice, a feeling of coma in the throat and impaired respiratory functions. Also, the patient begins to have difficulty swallowing.
- Flat warts in teens most often occur on the outer sides of the hands and lower face. The symptomatology is very blurry and is most often expressed in a mild and rare itch of the neoplasms.
Pathogenesis
In the presence of HPV in the human body, it is very often possible to conclude that the immune system is reduced. Once in the body, the viruses begin the process of infection of the basal epithelial layer, resulting in the main injury to the transition area from the stratified squamous to the cylindrical epithelium. In infected cells, 2 forms of the virus may exist: episomal (outside the cell chromosomes) of a benign nature and introsomal (integrated into cellular genomes) with a malignant nature of parasitism.
The incubation period of the papillomavirus can vary from the time the virus enters the body to the first manifestations of the disease over a period of between 14 days and a couple of years. The nature of human papillomavirus infection is usually latent, that is, hidden. At the same time, several varieties of pathologies can settle in the human body at the same time, and under the influence of certain factors, each of them can simultaneously begin to manifest itself through active reproduction. In this case, a stage of the disease occurs, at which clinical manifestations begin to be identified.
Very often (up to 90% of all cases of HPV infection), the human body self-heals from this pathology within 6-12 months, but in 10% of the remaining cases the disease can become chronic with along course, relapses and the possibility of malignancy of the process.
Diagnosis of the disease
Ultrasound for papillomas
Ultrasound examination in the diagnosis of papillomas is not used as the main research method, but as an additional method, confirming the correctness of the alleged diagnosis. Basically, ultrasound is used to diagnose papillomas in internal organs when it comes to their malignant transformation.
Ultrasound is used among the instrumental verification techniques for the diagnosis of intraductal papilloma.
Carrying out an ultrasound examination in this case does not allow the specialist to examine the ducts of the mammary glands, however, it helps to differentiate intraductal papilloma in relation to the alleged breast cancer, allows to exclude galactorrhea in prolactinoma. In addition, ultrasound can help detect the onset of neoplasms with papilloma of the bladder. However, ultrasound in this case is effective only if the neoplasms exceed 1 centimeter in diameter.
PCR diagnostics during diagnosis
The diagnosis of the disease in question is carried out by doctors, dermatologists and venereologists. Since the number of virus types differs, it is important to accurately determine the patient's type of infection and whether this strain has an oncogenic character. Visually, it is possible to make an accurate diagnosis only in the case of classic genital warts, which is why, if an HPV infection is suspected, specialists always use PCR scraping.
The polymerase chain reaction (PCR) invites researchers not only to determine the presence of HPV in the body, but also demonstrates its type, oncogenicity and number of viruses at the time of diagnosis. This is very important in diagnostic terms, since if there is information about the percentage of the virus in the body, it is possible to determine the approximate time of infection and establish contact persons for the patient to conduct etiotropic therapy.
Based on the results of PCR diagnostics, it is possible to determine the chronic course of infection or its occasional outbreak due to a decrease in immunity. This information gives the specialist the opportunity to prescribe an appropriate therapy for a specific case. Usually, PCR diagnostics is done in the form of screening. If the presence of a virus in the body is confirmed, the patient continues to be examined using other techniques.
HPV biopsy
Biopsy in medicine refers to the procedure of taking human tissue samples for their subsequent examination by staining with special dyes. Biopsy is very common for cancer, as well as for suspected HPV. On the eve of papillomavirus treatment, doctors must exclude the oncological nature of neoplasms.
Biopsy is a highly accurate diagnostic technique which, if HPV is suspected, can be expressed in cytological or histological studies.
Cytological examination is a study of the body's cells under a microscope, designed to demonstrate to specialists the changes that a viral infection has caused in these cells. For the prevention and early diagnosis of cervical cancer, cells for cytological examination in a woman are taken from this organ. If oncogenic HPV types are detected in women, even in the absence of external manifestations and signs, they are assigned cytological studies annually, allowing them to timely see signs of cervical dysplasia. The fact is that the dysplasia of this organ is completely treatable, and if the development of the process is not started, cervical cancer in the body will not develop at all, even with an oncogenic type of virus.
In order to accurately diagnose HPV, a histological study is conducted, for which not a superficial cell scraping is taken from the patient for analysis, but a piece of tissue, which allows to examine the correct position of the layerscell characteristics, tissue characteristics and identify oncological characteristics. When carrying out a histological examination with the help of solutions, the taken tissue sample is dehydrated and embedded in paraffin, after which the sections are made using a microtome, which makes it possible to obtain layers with a thickness of 0. 1 millimeters. The removed layers are stained with special dyes to reveal pathological cells during microscopic examination and to determine their nature.
Treatment of papillomatosis
Treatment of papillomavirus is always carried out according to an individual scheme. If a virus is detected during the diagnosis, but there are still no manifestations, the patient is prescribed etiotropic cytostatic therapy, which effectively "cradles" the virus for several years.
If a person is a carrier of HPV, they must undergo regular PCR diagnosis to identify the early signs of disease development. Also, the carrier of this virus is obliged to use barrier contraception in order not to infect sexual partners.
When papillomaviruses are detected, it is mandatory to use antiviral agents in the treatment. In general, immunomodulatory and vitamin preparations are indicated for all patients with HPV.
When papillomas appear on the mucous membranes or on the skin, depending on the location and symptoms, cryodestruction, electrocoagulation and laser removal of growths are used. Sometimes papillomas are removed even with a more modern technique, using radio waves. In case of signs of malignancy of the papilloma, it is surgically removed along with the surrounding healthy tissues around the growth. It is also important to know that removing the papilloma does not lead to a complete cure, as the virus remains in the body and can recur.
There are no drugs for the complete elimination of this virus from the body in modern medicine, therefore, when such a diagnosis is detected, even in the absence of manifestations, a person must regularly undergo examinations to detect the development ofpathology.
Since papillomavirus is more often sexually transmitted, it is worthwhile to prefer a barrier method of contraception, and if a woman is planning to become pregnant, it is important to carry out diagnostic measures in a timely manner and take therapy that will reduce the likelihood of infection of thechild with this virus.
Disease prevention
It is possible to prevent the appearance of papillomas on the body by observing the basic rules of personal hygiene and timely disinfection of any wounds. It is imperative to use a separate towel, comb, manicure devices, shoes for each family member in everyday life, and inconsistent sexual contacts should always be protected with condoms. It is also important after intercourse to always shower and treat the contact areas of the skin and mucous membranes, as the virus takes some time to enter the human body.
In modern medicine there is also a vaccine against the papillomavirus. It has already been tested in 72 countries around the world and is effective against 16 and 18 subtypes of HPV, which cause cervical cancer in 90% of all diagnosed cases. In addition, vaccination successfully fights viruses of subtypes 6 and 11, which cause the development of genital warts, which are difficult to treat. Due to the sexual route of infection with these viruses, it is recommended to vaccinate before the start of a person's sexual activity. Most often, experts recommend using the vaccine three times for girls aged 11 to 12. The World Health Organization also recommends vaccinating children to prevent the possibility of HPV circulation.
Are papillomas dangerous?
Papillomavirus is a risk factor for the development of oncological pathologies. Most often, due to this virus, cervical cancer occurs, cancer of the external genital organs (vulva, glans). However, HPV infection doesn't always lead to cancer. There are many subtypes of this virus with a low oncogenic index, for example, subtypes 6, 11, 42, 43, 44, which form warts, but there are also highly oncogenic subtypes - 16, 18, 31, 33, which cause flat warts. From the moment the virus enters the body until the transformation of a neoplasm into a malignant one, it can take 10 to 20 years.
If there are large papillomas on the body, which can be easily damaged in everyday life, they must be removed.
If the papillomavirus, which is detected in the body, is not treated, the risk of getting other infections increases significantly. And with the course of parallel infectious processes, papillomas begin to appear in other parts of the body, weakening the immune system. It turns out to be a vicious circle. Moreover, if some papillomas are not removed, they can degenerate into oncological neoplasms, which means that this disease must be approached with all seriousness and never let the course of the disease take its course.